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HomeMy WebLinkAbout032-1089-30-200 Q o °' O 3 0 00 O u!) b y ry 0. 0 C O U j ., Q E O N v O C N L C N LO i N a) j'. L > w ..0 pO w r E c ° N 0 o m o O Y C N (D c Z N = @ LL c Y ° ° c 1 = o a _ — ° o ° U) Q !E N o o N N w z E rn z I' C v Z v CL m M F- (n O U O Z d' w 0 N o fq H r O N Z c E M CL I _�V N Q1 N c O o a) Q Z m Z N z N � N m - d �l d N C w w O c Lo \I O y N N >' p LO o o a a CO J� Q p fn !A V) a z N > § 3: 3� 3: F m z ; O O O a a a a 7 o N O O O N Pftfta CD fn , E to m 2 O N C N O R N Q 3 U O o f aUi c c a °o 6 N _ O � N > C N N C O O O C O N N � Z Z d -;-,o c, M E N N y E E U O � w r E V E N d a r A V a l 1' O N V Parcel #: 032-1089-30-200 02i21i2007 04:46 PAGE10F 1 Alt. Parcel#: 33.31.19.426A-20 032-TOWN OF SOMERSET Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-BELISLE, MARK E MARK E BELISLE 1863 45TH ST SOMERSET WI 54025 Districts: SC=School SP=Special Pr 7192ND ess s): '=Primary Type Dist# Description '457 VE 2 h7® z SC 5432 SOMERSET SP 1700 WITC I� 0 � ' ST, Legal Description: Acres: 10.000 Plat: 4027-CSM 15/4027 SEC 33 T31 N R1 9W SW NE BEING LOT 2 CSM Block/Condo Bldg: LOT 2 15/4027 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-31N-19W SW NE Notes: Parcel History: Date Doc# Vol/Page Type 11/14/2002 698490 2047/340 QC 07/23/1997 372/57 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 83,000 100,600 183,600 NO Totals for 2007: General Property 10.000 83,000 100,600 183,600 Woodland 0.000 0 0 Totals for 2006: General Property 10.000 83,000 100,600 183,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/15/2005 Batch#: 05-13 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 032-1089-40-100 02i21i2007 04:47 PAGE 1 OF F 1 1 Alt. Parcel#: 33.31.19.426C 032-TOWN OF SOMERSET Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-BELISLE, COLLEEN ANNE COLLEEN ANNE BELISLE C-MOGREN, KEITH A KEITH A MOGREN 1865 45TH ST SOMERSET WI 54025 Districts: SC= School SP=Special Property Address(es): '=Primary Type Dist# Description * 1865 45TH ST SC 5432 SOMERSET �- SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 33 T31 N R1 9W SW NE 5AC LOT 1 CSM Block/Condo Bldg: 7/1926 MD 885/605 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-31N-19W Notes: Parcel History: Date Doc# Vol/Page Type 09/27/2006 835449 QC 08/03/1999 607968 1446/428 QC 07/23/1997 1114/292 WD 07/23/1997 870/183 more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/05/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 58,000 70,100 128,100 NO Totals for 2007: General Property 5.000 58,000 70,100 128,100 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 58,000 70,100 128,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total p 0.00 0.00 0.00 981–EZ–h8 ##qoC u0slaN TTajJeO Aq p043e.ip seM 4uawnj4sut st44 OOT 0 05 OOI 926T 3Jdd L 3Wll10A 133 N 17 1�_l v ££ uo140aS n ££ UOT4°0S 30 I3N 044 30 autl g4nos ua4ua0 �— ITT'059Z Mu0010£o68N 4uawnuoW A4uno0 IZO'£99 ££ uoL43aS MIILOIZ£ TON uauuoo I3 -------------------------------- ° 9Z8 •6d `E •IoA deW AaAUnS pai3tJa3 1N3W3SV3 105.8Z£ MIIOOIOE 68N I OV08 31VAIdd aP!m I££ 100'L6Z I fly 15£'L6Z 34010E068S -- — IE£ I££ a Y 1N3W3SV3 Md 31VAIad aPIM I££ v��, (`a ., dNb SZOhS '?M 4asiawos �O SIIA V£OZ xoq 1 1 INGIS(in" ` alstlag aoelleM ml r LObG'S d]NMO �1 N30VHAN + 1 • '3 N3TIV A1NOM Xlogo, 'is LI �as 11330 •- M 3 R7 1 • O N I C W .0 1 n I t0 10 = _ .. TI _ I^ � I p TI T 101 CO. I vI - N M O N I 3 1 p C I OI w M °) 31 I = of M/8 9NIOnl0X3( 'aV SE'h N ('43 'bs Z9h'681 3 N c 41 CD S bI s o I o u� m � 3 ° ° 11 N M/8 9NIonIONI(.43 •bs.Z58oOTZ 'on am' I R I cli 41 i� z o.l z r CH CI CL) , TJ Jn 3 N L U O n 6/ C 41 O d1 N - C of ra u 4) o L w z I m co L I b � w N Z 01 C N L 4+ N 41 ° s�9 ' Ias•£oE I I3N 044 30 IMS a44 30 autl 44JOu I ------------------------------- sja44o Ii'q pauno spuel pa44eldun 4uawnuoW A4uno0 '40s '4003 .leaull/sql 89'1 6u146iaM adtd uout uhZ x III O E£ uoT300S Jaujoa IN puno3 adtd uojt 111 • QN]911 'NISNOOSIM 'A1N1100 XI02l0 '1S '13S83WOS 30 NMOI 'M618 'NTEl '££ NOI103S 30 I3N 3H1 d0 IMS 3H1 30 18Vd NI 031VO01 ddW AIAHS GIIdIAID � e �J rnrraNU�,,o s��nrr v J fi3,1"7bf MAY 16 2001 ]D gym: �rz0' r';,`;,:�TV 1 CE tTH�' `" ' MAP N Located in part of the SW1 14 of the NE1 14 of Section 33, W Z T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. O ui o�. o 8 OWNER afigS-7 v LL*- CAROL BELISLE Z o LU PREPARED FOR w M MARK BELISLE w 10D 1863 45TH STREET 1 Ic S SOMERSET,WI 54025 S ° FILED cn°� 2 In Z o� $ JAN 3 1 2001 ► ZC aD 3 St.CtogcCo.wl L NORTH LINE OF THE SW1/4 OF THE NE1 14 (N89°42'09"W) N89 041'22'W 689.16' N lz� + N1/4 CORNER LOT 2 SECTION 33 Q 1'p 1Q & 10.000 ACRES Z I�.� p N 435,600 SQ. FT. O = O *4 w W 1 1 X11 m P V M 133' 33i ��I� ®HOUSE /- ��1 1� 1° ❑ 1 U�� I ; �, o � 1 I ;X .............................................. a........................................ DD 1 6 6, 1 0 o - 1 �ia3_ _ _ ? N89°30'00"W % 689.24' r'- I OUTLOT 1 w _ (FOR ROADWAY PURPOSES) °� �) S89°30'00 1E 331.51' $89 030'00"E 689.24' I Q 66'WIDE PRIVATE ROAD EASEMENT 1.044 ACRES �1 0�� �/ � 45,490 SQ. FT. 1Q co W 1 N 1 ,� 2 nom • I I I - 1�--- �� A I J) �I � '�10 �apdGQ44C�D_L�G1aD� III m c 13 LEGEND ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND S1/4 CORNER • 1"IRON PIPE FOUND A WED O 1"X 24"IRON PIPE SET WEIGHING ST.CROIX COUNTY 1.68 LBS.PER LINEAR FOOT Planninq Zoninq and Parks Committee 1 00'ROADWAY SETBACK LINE . AN 3 12001 ® WELL A SEPTIC If not recorded within 30 days of ( ) PREVIOUSLY RECORDED AS ' approval date approval shall be mull and void --0—o— EXISTING FENCE LINE "" " F— EXISTING DRIVEWAY SCALE IN FEET 1 = 200 DATE: 10/19/00 DRAWN BY: WILLIAM KANE Mao 200 0 200 JOB NO: 00-105 Vol.15 Page 4027 PUMP CHAMBER s _ Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size , Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,© 'Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: r Width: 1.:2 Length: Number of Lines: Area Built: r Fill depth to top of pipe: / Number of feet from nearest property line: Front, Q Side, O Rear,0 It I MEW Number of feet from well: fj Number of feet from building:? (Include distances ,on plot plan). ( J SEEPAGE PIT t 9 �5� y , G. Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: v' Plumber on job: ,2 License Number: 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L L IA&(_ ��� ale TOWNSHIPJ/ ,,`jars er5�T SEC. T,j�N-R/�W ADDRESS �� �ioX ��� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y- I i i 3 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used re ,, ,�jhG ��. G v✓��'N Elevation of vertical reference point: D Proposed slope at site: SEPTIC TANK: Manufacturer: �e ��� Liquid Capacity: Number of rings used: Tank manhole cover elevation: to Tank Inlet Elevation: Tank Outlet Elevation: 9 Number of feet from nearest Road: Front Side ,O , Rear, O � feet . From nearest- property line ° Front,0 Side 10 Rear,O feet a3y. Number of feet from: well W119, 4- , building: 3 t (Include this information of the above plot plan)(-2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS 1.ARITR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 SW1,4, NE14, S33,T31N-R19W KXCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (lf assigned) Town of Somerset ❑Holding Tank ❑In-Ground Pressure ❑Mound 45th Street NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPEC 10 ATE: Wallace Belisle Route 2, Box 468. Somerset WI 54025 41 -s$ BENCH MARK(Permanent reference poln0 DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT.ELEV. Name of Plumber JMP/MPRSW No.: County Sanitary Permit Number Byron Bird Jr. 3318 St. Croix 102846 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ]LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNDEDLAB L PROVIDEDOVER PROV�/ �� /ot� ��Uf �7 I�, �� KYES ONO OYES BEDDING. ([VENT CIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDFEET//'� _ ALARM �j LINEz DYES �O -4 ( `z OYES O INEARESTM r� �`�� no DOSING CHAMBER: MANUFACTURER BEDDING. LIOUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING OVER PROVIDED OYES ONO ❑YES ONO OYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPE RAT IONAL. NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH . LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES Ell NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing ENGTH DIAMErEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. L NO.OF DISTR PIP SPACING COVER INSIDE CIA ss PliS LIQUID BED/TRENCH I THENC^E S. /E MA RIAL: PIT DEPTH DIMENSIONS �n yP� GRAVEL DEPTH FILL DEPTH IS PIPF DISTR.PIPE DISTR PIPE MATERIAL: NO DISTR. NUMBER OF PRO�TY WELL BUILDING AIR I TO FRESH BELOW PIPES s t ABOVE COVER.JEDLETV".INLET ELEV.END. PIPES FEET FROM LINE ^ AIR INLET 1y / C NEAREST �� 11'NJ. COd C�o�t MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ONO SOIL COVER TEXTURE P MARK EHS OBSERVATION WELLS ❑YES 0 N 1:1 YES E:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MN O DISTR DISTR.PIPE UISTHIBU T ION PIPE MATE HIAL.&MAHKIN(, ELEV. ELEV.. CIA.. ELEV.' PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY=LDING ^ FEET FROM LI"E u D YES : NO DYES ❑NO NEAREST o �E 4C/ ---------------------------- T Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. DILHR SBD 6710(R.01/82) C Zonin Administrator C�. f INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION T = TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; .2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; r V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground 8tef included the creation of surcharges (fees) for a number of regulated practices which Wisco ir3's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T>?t&UfiB: is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) i �' DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code '"° STATE SANITARY PERMIT# /va �11(4 -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. -See reverse side for instructions for completing this application. FFORI TION 1. APPLICANT JNFORMATION-PLEASE PRINT ALL INFORMATION. VARI ANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION e �'/a %a,S T , N, R E(ooV PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISI N NAME Q A 41,,5 g CIT ,STATE ZIP CODE PHONE NUMBER CITY REST R AKE OR LANDMARK el- bZs— VILLAGE: P 11. TYPE OF BUILDING OR USE SERVED: — A0W•-C90-000 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a.'N New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. VConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.El Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Mseepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): �r p 4 3 r0 1 6 41- /�,� Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank .LAC Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Si nature:(No Stamps) MP/MPRSW No.: Business Phone Number: ra4 � t �-r, � � Aoilr76� Plumb Add s (Street,City,S te, ip Code): Name of Designer/: e .Q/t� VIII. SOIL TEST NFORMATI Certified Soil Tester ST)Name CST# 0-0'007 l�o a CST's ADDRE ( , eet,City,State,Zip Code) Phone Number: 6 �g IX. COUNTY1-=12A RTMEN USE ONLY ❑ Disapproved Sanitary Permit F e Groundwater ate Issuing Agent Signature(No Stamps) EN Approved ❑ Owner Given Initial �` CGroundwe Fee fig. Adverse Determination I3o, � �"'&�-,n, X. COMMENTS/REASONS FOR DISAPPROVAL: `S 04 ru-\�p d 41 SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. w Owner of Property /,� Location of Property ( 1% ._�t, Section , T 3f N-R W Township ,S(*,(\,e � f^ / Mailing Address C�'V Address of Site Cam/ Subdivision Name . Lot Number Previous Owner of Property Total Size of Parcel Date Parcel vas Created (�' ba Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) cvai.6y that dU Atatementh on tW bOAm cute th.ue to the but o6 my (owt) hnowtedge; that I (we) am (ahe) .the owneAkl o6 the phopenty de�scAi.bed in thiA .i"4011ma ion 6onm, by viA-tue o6 a wamant de SK ded to the 066.ice o6 the Cocutty RegiAteA oA Veed�s ass Vocumen.t No. . ; and that I (We) pne.eentty cxun Use phopoa¢d d c to bon the sewage diAPO (on I (we) have obtained an eaeen+¢nt, to hun with the above descA bed pnopeJrty, bon the conatnucti.on 06 said eya•temp and the came ha-6 been day h eotded in the 0661ce o6 the County Reg.ie,ten o6 Veeda, a6 Vocwnent No. J . c SIGNNATUREE Op OWNER 7 SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED ' DATE SIGNED It.,200. wnrrnnq nrrd--To Huah"d and Wife a%d tift IZ"nmdn. en e e I + 6 3 Inbenture, Made this 3rd. day of October ,1960 , between Roderick Belisle and Adele Belisle, husband and wife and each F . in their own individual capacity, of the Town of Somerset, St. - . Croix County, Wisconsin - Parties of the first part,and Wallace A. Belisle and Carol Me Belisle, of the same place; , husband and wife,as joint tenants, parties of the second part. UAltntooeth, That the said part ies of the first part, for any, in consideration of the sum of i . Two thousand (w2000.00) and no/100 — Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted.bargained,sold,remised,released,aliened,conveyed and confirmed,and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate situated in the County of St. Croix . Wisconsin,to-wit: The South Half of the Southeast quarter (SJSE4) of Section Number Twenty-eight (2(') the Northeast quarter of the Northeast quarter (NENNE,J and the South Half of the Northeast quarter (SANE») of Section Number 'Thirty-three (33 ) , all in Township Thirty-one (31) North of Range Number Nineteen (19) West; ICI 3 3 eCogttbtt, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining, and all the estate, right, title, interest,claim or demand whatsoever,of the said part i e s of the first part.either in law or equity,either in possession or expectancy of,in and to the above bargained premises,and their hereditaments and appurtenances. 'Co habt anb to I)olb, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part,as joint tenants. Anb the @alb, Roderick Belisle and Adele Belisle, husband and wife, part i e s of the first part, for themselves, their heirs,executors and administrators, do covenant, grant, bargain and agree to and with the said parties of the second part,and to and with the survivor of them, his or her heirs and assigns,that at the time of the ensealing and delivery of these presents they are well seised of the premises above described, e 4 BOOK PACE ;••, ,. .. -_rr cn. M r` .. ..i.•::t �..:;.nom ,.. .,••n •' �dOK e,71;? PACE 58 rls of a good, sure, perfect absolute and indefeasible estate of inheritance in the law,in fee simple,and that the some are free and clear from all ineumbrances whatever.' and that the above bargained premises, in 'the quiet and peaceable possession.of the said parties of the second part,as joint tenants, a, -rust all and every person or persons lawfully claiming the whole or any part thereof they Will FO -ever WARRANT AND DEFEND. 3n WttntOO Mterrot,the said part ies of the first he Vehereunto set their hand and seal s this 3rd. day of Octmber'/ , 19 60 Signed,.Sealed and Delivered in Presence of O i __. (Seal) _ ._..... Adele Belisle . E. u hes __.,..._.... ._...... ____... _._...........__..._................_(Seal) �� __....._...__................._..... _..._..,._... . ..._,.............._...._......_ (Seal) Eva G. Lynch Watt of wtoranotn, St. Croix ss. County. On this the 3rd. day of October , 19 60, before me, J. E. Hughes husbaM& a der�.'tee officer, personally appeared Roderick Belisle and Adele Belisle,,known (or satisfactorily proven) to be the person S whose name S subscribed to the within ins'rument and acknowledged that the V executed i the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary Pub ic, St. Croix County, Wisconsin. My Commission expires November 20 , 19 60. (To be filled In It signed by a \otarr Public.) I:Y.A•—ch.611 Win.state. ororldea that all Indramenla to be reeorded.hnll bave OLtnlr printed or trvetrritten Ibereee the name0 of the lrroolor.•trrantee.•arttnen.em and noted.) w p tIS! A 4r co (b; ^�E Fnl N r"1' ti tt100 4 .1 tt!; to l l A W v w � C <. �. •a f c •r( N d; •rl y Q . h o Co. .A • to o U u V Q1 ,H! .b u •r(E �? V� a+j�rl 0 � N O r4 IJ tUi r-I:d r_1j Of W t o 0f ,0N,.4�-(t �' CJ a oc �; H z • H ST C - 105 r" a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z ti C) a H OWNER/BUYE ROUTE/BOX NUMBER �°L Fire Number � �j CITY/STATE ��i?_ C-�1/4` ZIP 14 PROPERTY LOCATION : , , Section) , T N , RW, Town of , St . Croix County , Subdivision , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents m_L be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . H 0 E z I/WE, the undersigned , have read the above requirements and agree L, to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE �� St . Croix County Zoning Office P . O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . i INSTRUCTIONS FOR COMPLETING FORM 115 - S 3I - 6395 y To be a€omplete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this-is a residence or cornmercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; Pi. PLEASE use the abbe eviations shown here for writing profile descriptions and completing the plot plan, 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your bench mark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data,percolation test exenip- Lion,if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N_A.in the appropriate box; 11. Sian the form and place your current address and your certification number; 12. Make legible copies and distribute as required, ALL SOIL_ TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Soil Separates and Textures father Symbols st — Stone (over 10") BR Bedrock cob Cobble (3- 10") SS Sandstone gr -- Gravel (under 3") LS — Limestone 's Sand HGW - High Groundwater cs — Coarse Sand Perc — Percolation Rate med s Medium Sand W — Well fs — Fine Sand Bldg --- Building Is Loamy Sand > — Greater Than Ksl Sandy Loam < -- Less Than 'I — Loam fan - Brown sd Silt Loam BI — Black s — Silt Gy •. Gray cl Clay Loam Y — Yellow scl — Sandy Clay Loam R Red sicl - Silty Clay Loam mot Mottles sc Sanely Clay w, with sic — Silty Clay ff l: — few,fine,faint *c _.. Clay cc - common,coarse lit .._ Peat mm — Many, medium r-rs — Muck d — distinct p prominent HWL - High water level, Six general sail textures surface water for liquid waste disposal BM — Bench (Mark VRJP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. O i s��c 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: fOWNSH /MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: sw�/V*�/ /T/ N/R E (or)W 7L COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: CJ- rai e USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROF1 LE DESCRIP T IONS: PERCOLATION TESTS: �AQesidence New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optiona s ❑u s ❑u s ❑u ❑s u ❑s u If Percolation Tests are NOT required DESIGN RATE: jwMi/Ifj If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicatey Floodplain,indicate Floodplain elevation: O l,g PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- �eo o-/C'clr-Y4 gi X-C- 4g!� vi/,2f 9 0 B-.� ©G'� Dti &? -/D d.— /�/� S� c� 'rte g /� Si ��-�` q B- 3 p,�.� ��p eIr� '0:' A0 -v7 Y �0 rvA"-4'C/ nom 5� B- �1�f7 B- ��f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- J P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION - �5 i 02 2 E , 3 ®ro 1 , E ccc f "` ( T 61:-- , N HA A- � tJ.�6'rntr �� `'�' Sal { 1 I m. I_. __ ___m_ __ , M _ 3 owo' , �r E 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: ra-) x&Z �e— 7--4' DDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 71 CST SIGNA R 03i ION: Original and one copy to Local Authority,Property Owner and Soil Tester. 95(R. 10/83) —OVER — PLOT PLAN IP R O JIE C T 4 GIGS ADDRESS TOWN X1,�5 �e,.sjqtOUNTYf� MPRS Byron Bird Jr. 3318 DATE t� ,�=2 BEDROOM a� CLASS PERC � CONVENTIONAL_ZIN-GROUND PRESSURE CONVENTIONAL LIFT_ MOUND_HOLD G TANK SEPTIC TANK SIZE try � LIFT TANK SIZE DOSE TANK SIZE — HOLDING TANK SIZE ABSORPTION AREA 6 YO PERC RATE BED SIZE 1.-;2- S 3/ 11116 Benchmark V.R.P. Assume Elevation 100' w0410' "J Location of Benchmark a- e- O 3'1� /� // L-�'� alo- c 2C ,k-7 * H.R.P. d rr z�49. - 0 Borehole 0 Well Scale = Feet r O Perc Hole G �System Elevation y� TYPAR COVERING A 2" 12" 3' 4 g' @ 3' 3' 3' { 6" Sewer Rock 18' i 12' L Ca aq a 15-2 OAJ - , .53' 3' , r( `' ro' a t iS Ae. ¢lie.•_ o �rG � �, . ,-, ._. _-�"r�.� �. 1 �/h' // 1 �< ��%� ,�� �I �� 7 I I